End Diagnostic Overshadowing:Addressing Ableism in Diagnoses

Summary

People with disabilities (PWD) experience increased risk of diagnostic error-sometimes due to attributing symptoms to disability rather than a potentially new or co-morbid conditions. As well, some diagnoses are prone to error. Based on literature we identified the following twenty-six with ICD-10 codes: Aortic aneurysm and dissection I71.0 - I71.9; Arterial thromboembolism I74.0 - I74.9; Venous thromboembolism I82.0-I82.99 and I82.A-I82.C; Congestive heart failure I50.1-150.9; Stroke All I60, I61, I62, I63, I64; Myocardial infarction I21.0-I21.9 and I21.A-I21.B; Spinal abscess G06.0, G06.1 and G06.2; Meningitis and encephalitis G04 -G04.91; Endocarditis I33.0-I33.9 and I38; Sepsis A41.0-A41.9; Pneumonia J12.0-J95.851; Lung cancer C34.0-C34.92; Melanoma C43.0- C43.9; Colorectal cancer C18.0-C18.9; Breast cancer C50 to C50.929, and C79.81; Prostate cancer C61; Pediatric Arterial ischemic stroke I63.0-163.9xx; Appendicitis K35-K35.8xx; Asthma J45.2-J45.998; Retinal blastoma C69.20, C69.21, C60.22; Brain tumor C71.0-C71.9; Polyateritis M30.0-M30.8; Congenital heart disease Q20 - Q28 (Q24.9 particularly important); Duchense muscular dystrophy G71.0-G71.9; Inflammatory bowel disease K51.0-K51.9; Scleroderma M34.0-M34.9.The goal of this research is to identify and create understanding of what underlies and contributes to increased risk of diagnostic error with these diagnoses. The investigators plan to develop ways to reduce it, specifically ways to identify people with disabilities at risk of diagnostic error (DE). The investigators will also develop education programs and decision supports targeted to healthcare professionals. If it is effective, ways to reduce diagnostic error will have been developed among people with disabilities.

Conditions

• Disabilities Multiple

Interventions

BEHAVIORAL

Electonic health record prompts with education

1). A baseline audit of diagnostic processes (including data from the Safer DX Checklist and CPT E/M code usage) for patients aged ≥ 3 to 89 years with one or more of 26 diagnoses prone to error to compare cases of PWD with specific disabilities (major mobility impairments,1 mental health concerns,2,3 severe visual impairments/ blindness,4 severe hearing loss/deafness,5 and IDD6,7) versus without the disabilities. Using analyses of data, chart reviews, staff interviews and mock tracers, a frame of themes underlying increased risk of DE will be co-produced to develop algorithms to identify patients with the specified disabilities at risk. Case studies for education on DE, and EHR prompts, alerts, and decision supports related to the algorithms will be co-produced along with education on the EHR materials. Evaluate for change in use of diagnostic processes among PWD post implementation of algorithms and EHR prompts, alerts and decision supports will be conducted post-intervention.

OTHER

Standard of care

Patients without disabilities will receive standard care related to electronic health record prompts, alerts, and decision supports.

Sponsors & Collaborators

• St. John Fisher College

  collaborator UNKNOWN

• University of Minnesota

  collaborator OTHER

• Rush University Medical Center

  lead OTHER

Principal Investigators

• Sarah H Ailey, PhD RN · Rush University College of Nursing

Eligibility

Min Age

3 Years

Max Age

89 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2024-11-22

Primary Completion

2029-03-31

Completion

2029-07-31

Countries

• United States

Study Locations